Documenting Mobility Part 5: Sit to Stand and Standing

Overview

• Lecture on documenting mobility: sit-to-stand and standing. Focus on consistency, flexibility, efficiency, and key documentation elements.
• Includes examples, poor vs. good documentation, and goal-writing aligned to patient context and safety.

Sit to Stand: Key Components

• Positioning near front edge of chair before standing; sliding forward improves success.
• Stand with control and symmetry; avoid momentum-only strategies and plopping on descent.
• Use of armrests and assistive devices; document whether needed and how used.
• Surface type and height matter; record bed/chair/couch/car heights and match home setup.
• Balance upon achieving standing; note stability immediately after rising.
• Environment variety: bed, toilet, recliner, couch, car, office chair; plan for all relevant sites.
• Floor surfaces: carpet, wood, gravel driveway; note impact on difficulty and safety.
• Therapist role: level of assist, cueing type, technique instruction, and hands-on actions.
• Symmetry and movement strategy: weight shift right/left, trunk rotation during transitions.
• Motor control on ascent and descent; document eccentric control and physical effort.

Sit to Stand: Structured Documentation Elements

• Assistance level with specifics: type, amount, cues, equipment, and surfaces.
• Environmental parameters: surface height, location, floor type, and home match.
• Patient performance: ability, balance, control, symmetry, and effort.
• Caregiver training: education provided, technique, safety, and demonstrated competence.
• Problem-solving considerations: equipment options, timing, discharge readiness, team input.

Sit to Stand: Case Example (Right TKA, Same-Day Discharge)

• Hospital bed at lowest equals home bed height (20 in) unsuccessful; raised to 24 in succeeds.
• At 24 in: sit-to-stand with verbal cueing, steadying assistance, walker; balance concerns due to anesthesia.
• Stand-to-sit: verbal cues for hand placement to ensure controlled descent and safety.
• At 20 in: requires Max Assist with gait belt and walker; indicates home safety risk.
• Wife trained to assist from 20 in bed: first with PT cueing, then independently with safe technique.
• Document availability of walker and gait belt at home to ensure continuity and safety.

Sit to Stand: Example Documentation vs. Poor Documentation

• Good: specify heights, assistance, cues, equipment, balance status, and caregiver training outcome.
• Poor: “sit to stand from bed with contact guard” lacks environment, home applicability, and education details.

Sit to Stand: Discharge Planning and Problem Solving

• If caregiver cannot assist: consider equipment (e.g., bed risers) and delivery timing before discharge.
• Assess need to delay discharge if home function unsafe; bring concerns to team.
• Document all problem-solving steps and team communication related to safety and readiness.

Standing: Key Components

• Ability to stand without assistance; progress from UE-supported to unsupported stance.
• Reaching out of base of support and balance capacity addressed in a separate module.
• Standing duration required for function; aim for meaningful time targets in goals.

Standing: Case Example and Documentation

• Patient stands with UE support; training focuses on no UE support.
• Needs contact guard to maintain balance, continuous steady hand, and verbal cues for symmetry.
• Can stand 20 seconds per trial; requires 60 seconds rest; repeated for five trials.

Standing: Structured Documentation Example

• Intervention: static standing without UE support.
• Assistance: contact guard; steady hand maintained throughout all attempts.
• Performance: five trials, 20 seconds each, 60-second rests between trials.
• Cueing: verbal cues for symmetrical weight-bearing during each trial.

Key Terms & Definitions

• Contact Guard (CG): therapist maintains light contact to assist balance without lifting.
• Max Assist: therapist provides most effort to complete the movement safely.
• Eccentric Control: controlled muscle activation during lowering phase to avoid plopping.
• Base of Support (BOS): area beneath a person that includes every point of contact with support surface.

Example Goals

• Acute care sit-to-stand goal: patient’s wife will safely assist sit-to-stand from a standard 20 in bed using gait belt.
• Standing goal: patient will stand independently without UE support for 5 minutes, no rest, with symmetrical weight bearing.

Action Items / Next Steps

• Match practice surface heights and types to home environment; verify exact measurements.
• Train caregiver with cues and body mechanics; document first with cues, then independent safe performance.
• Consider equipment solutions (e.g., bed risers) and logistics before discharge when needed.
• Communicate and document discharge readiness concerns if home function is unsafe.

Sit to Stand and Standing: Summary Table